The survey is only the latest attempt to explore the interplay between the pharmaceutical industry and the medical community amid ongoing concerns that financial relationships may unduly influence medical practice and research. Such concerns have prompted government probes, a new federal law designed to promote transparency (read here about the Sunshine Act) and regular monitoring by the American Medical Student Association (see this).
Here are some numbers: Among 1,610 students and 739 residents who responded to the survey between February and May 2011, there was frequent contact with reps. Nearly 17 percent of first-year students attended an industry-sponsored lecture in the previous six months; the rate was 40 percent for fourth-year students and nearly 36 percent for residents. Just 5 percent of first-year students attended a meal off campus, but 13 percent of fourth-year students and 27.5 percent of residents did so (here is the abstract).
Gifts were abundant - 33 percent of first-year students reported receiving something, compared with 57 percent for fourth-year students and 54 percent for residents. Pens, notepads and T- shirts were most common among first-year students at 19 percent, while food or beverages in the workplace were most common for 47 percent of fourth-year students and 35 percent of residents.
Interestingly, both first-year and fourth-year students - 7 percent and 14 percent, respectively - received free samples, despite lacking authority to prescribe drugs themselves. About 14 percent of residents reported receiving free samples. As for meals outside a campus or hospital, these were reported by 5 percent of first-year students, 13 percent of fourth-year students and 27.5 percent of residents.
About two-thirds of medical students and residents stated that sales reps should be excluded from interactions with "pre-clinical students" while between 53 percent and 60 percent expressed the same sentiment about interactions at clinical sites. But few trainees reported understanding the conflict-of-interest policies and only half of fourth-year students and residents felt that faculty complied. And not many fourth-year students or residents felt very prepared to recognize conflicts.
Also, "the perception that industry interactions lead to bias was prevalent, but the belief that physicians receive valuable education through these interactions increased - 64 percent of first-year students to 67.5 percent of fourth-year students to 80 percent of residents," the authors write.
As far as attitudes toward industry, "nearly 26 percent of first-year students, 22.5 percent of fourth-year students and 35 percent of residents saw no problem with accepting gifts from reps. More students and residents felt that such gifts would affect the behavior of others than their own behavior. Similarly, students and residents found industry-sponsored grand rounds helpful and educational, even as they indicated rounds were biased in favor of a company’s products."
"Interactions between medical trainees and the pharmaceutical industry are controversial, and our survey shows that many trainees now find these interactions unwarranted," says lead author, Aaron Kesselheim, an assistant professor of medicine at Harvard Medical School and a faculty member in the Division of Pharmacoepidemiology and Pharmacoeconomics in the Department of Medicine at Brigham and Women’s Hospital.
"However, gifts, meals outside campus, use of industry-sponsored educational materials, and even free drug samples persist among trainees. Though some academic medical centers have moved to restrict interactions between trainees and industry, it appears that further efforts will be needed to ensure that these restrictions effectively permit trainees to learn the fundamentals of their profession in the marketing-free environment that many of them crave."
pic thx to jerome kassirer